Osteoporotic-related fractures are a serious problem for patients with Spinal Cord Injury (SCI). However, best management for acute care of these fractures including whether surgical vs. nonsurgical treatment should be done and the factors that influence this decision is not known. This point is well appreciate by providers, who have identified to SCI QUERI that research to establish best practices for treatment of fractures in patients with a SCI should be a priority area. Surgical treatment for lower extremity fractures is done more frequently than previously reported, with approximately 10-37% of these fractures now managed surgically. However, the factors that influence the choice of surgical vs. nonsurgical fracture treatments and outcomes following these therapies have not been described. In this proposal we will utilize administrative databases, semi-structured questionnaires and case scenarios, and convene an outstanding advisory panel to review this information and existing literature to start the process of understanding best management for osteoporotic fractures in SCI. We will include both patients and providers (orthopedic surgeons and PM&R physicians) in the surveys. This proposal is of direct, immediate potential clinical benefit to the expanding population of patients with SCI. It will provide invaluable information for providers to better be able to care for these patients when they sustain an osteoporotic fracture.